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AB0428 An Exploratory Study of the Predictors of Good Eular Response, Das-28 Remission, Sustained Responses to TNF-Inhibitors Therapy in Refractory Rheumatoid Arthritis in Clinical Practice
  1. R.H.A. Mohammed
  2. on behalf of Mohammed Bukhari
  1. Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt


Background The recent era witnessed interesting advances in the therapeutic strategies of RA with TNF-I on top of the list.

Objectives Prospectively survey factors favoring EULAR good response, DAS-28 remission, sustained response to tumor necrosis factor inhibitors (TNF-I) in biologic naïve refractory RA patients.

Methods Observational study, a follow up period of 2 years, patients randomly assigned to TNF-I (Infliximab 5mg/kg intravenous infusion, Adalimumab 40 mg subcutaneous every 2 weeks, etanercept 50 mg subcutaneous weekly). Baseline demographic features, DAS 28, functional score (health assessment questionnaire), Pain score (VAS), plain radiography, RF, ACCP-A, recorded. The primary outcome: % of patients who achieved the EULAR good response/remission [DAS-28] at 6 months, secondary measure: % of patients sustaining their initial response over 2 years.

Results Eighty RA patients 64 females,16 males, mean age of 48.4±17.9 yrs, mean disease duration 7.3±5.9 yrs,mean DAS-28 6±1, HAQ 1.25±0.35, mean ESR 51.00±25.30 mm/hr, mean CRP 35.18±31.65 mg/l, 30 patients received infliximab, 30 received adalimumab, 20 received etanercept. At 6 months 56 patients (70%) achieved EULAR good response, 51.8% achieved DAS-28 <2.6. EULAR good response/ sustained responses to TNF-I significantly correlated with a positive IgM rheumatoid factor (RF) and a higher hemoglobin concentration (Hb%) at baseline P<0.01, inversely correlated with baseline DAS-28 and radiographic erosions P<0.05 (Table 1). Achievement of EULAR good responses by 6 months and sustained response at 2 years positively correlated with the decline in RF titers during the observation period. DAS-28 remission and sustained responses negatively correlated with baseline HAQ as well as baseline DAS (r= -0.18, -0.24, -0.74, -0.85, P<0.05). Regression analysis identified higher serum Hb%, sero-positivity to RF, lower baseline HAQ, absence of erosions as significant predictors of sustained response to TNF-I (ORs=1.35, 1.35, 1.32, 1.26, P<0.05). The concomitant use of methotrexate/DMARDS was associated with favorable EULAR responses and remission at 6 months (ORs=1.13, 1.35 respectively).

Table 1.

Correlation between baseline parameters and the responses

Conclusions Higher baseline IgM rheumatoid factor, a higher baseline hemoglobin concentrations, a lower baseline HAQ score, lack of radiographc erosions favored an EULAR good response at 6 months and were significant predictors for a sustained response to TNF-I.


  1. Nozaki Y, Kinoshita K, Funauchi M, Matsumura I. A response of TNFα inhibitor treatment outcome in patients with rheumatoid arthritis. OA Immunology, 2013 Apr 01; 1(1):1.

  2. Canhão H, Rodrigues AM, Mourão AF, Martins F, Santos MJ, Canas-Silva J et al. Comparative effetiveness and predictors of response to tumour necrosis factor inhibitor therapies in rheumatoid arthritis. Rheumatology (Oxford). 2012 Nov;51(11):2020-6.

Disclosure of Interest None declared

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